Using a French exhaustive dataset, this article studies the determinants of regional disparities in mortality for patients admitted to hospitals for a heart attack. These disparities are large, with an 80% difference in the propensity to die within 15 days between extreme regions. They may reflect spatial differences in patient characteristics, treatments, hospital characteristics and local healthcare market structure. To distinguish between these factors, we estimate a flexible duration model. The estimated model is aggregated at the regional level and a spatial variance analysis is conducted. We find that spatial differences in the use of innovative treatments play a major role whereas the local composition of hospitals by ownership does not have any noticeable effect. Moreover, the higher the local concentration of patients in a few large hospitals rather than many small ones, the lower the mortality. Regional unobserved effects account for around 20% of spatial disparities.
Using a French exhaustive dataset, this article studies the determinants of regional disparities in mortality for patients admitted to hospitals for a heart attack. These disparities are large, with an 80% difference in the propensity to die within 15 days between extreme regions. They may reflect spatial differences in patient characteristics, treatments, hospital characteristics and local healthcare market structure. To distinguish between these factors, we estimate a flexible duration model. The estimated model is aggregated at the regional level and a spatial variance analysis is conducted. We find that spatial differences in the use of innovative treatments play a major role whereas the local composition of hospitals by ownership does not have any noticeable effect. Moreover, the higher the local concentration of patients in a few large hospitals rather than many small ones, the lower the mortality. Regional unobserved effects account for around 20% of spatial disparities.
1
CEPR -
Center for Economic Policy Research
( 143559 )
- Royaume-Uni
CEPR ( 322082 )
2
PSE -
Paris-Jourdan Sciences Economiques
( 139754 )
- 48 boulevard Jourdan 75014 Paris
- France
École normale supérieure - Paris ( 59704 )
;
Université Paris Sciences et Lettres ( 564132 )
;
Institut National de la Recherche Agronomique USC1336 ( 92114 )
;
École des hautes études en sciences sociales ( 99539 )
;
École des Ponts ParisTech ( 301545 )
;
Centre National de la Recherche Scientifique UMR8545 ( 441569 )
3
PSE -
Paris School of Economics
( 301309 )
- 48 boulevard Jourdan 75014 Paris
- France
Université Paris 1 Panthéon-Sorbonne ( 7550 )
;
École normale supérieure - Paris ( 59704 )
;
Université Paris Sciences et Lettres ( 564132 )
;
École des hautes études en sciences sociales ( 99539 )
;
École des Ponts ParisTech ( 301545 )
;
Centre National de la Recherche Scientifique ( 441569 )
;
Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement ( 577435 )
4
INED -
Institut national d'études démographiques
( 57627 )
- Campus Condorcet
9, cours des Humanités - CS 50004
93322 Aubervilliers Cedex
- France
5
CEPREMAP -
Centre pour la recherche économique et ses applications
( 300479 )
- Ecole normale supérieure (ENS)
48 boulevard Jourdan, 75014 Paris
- France
Département d'économie de l'ENS-PSL ( 1151928 )
;
École normale supérieure - Paris ( 59704 )
;
Université Paris Sciences et Lettres ( 564132 )
Comité de lecture
Oui
Vulgarisation
Non
Langue du document
Anglais
Nom de la revue
Journal of Economic Geography
(ISSN : 1468-2702, ISSN électronique : 1468-2710)
Publié par Oxford University Press (OUP): Policy F
Revue non référencée dans Sherpa-Romeo
I - Health, Education, and Welfare/I.I1 - Health/I.I1.I11 - Analysis of Health Care Markets
C - Mathematical and Quantitative Methods/C.C4 - Econometric and Statistical Methods: Special Topics/C.C4.C41 - Duration Analysis • Optimal Timing Strategies
Domaine(s)
Sciences de l'Homme et Société/Economies et finances
Financement
Ce travail a bénéficié d'une aide de l'Etat gérée par l'Agence Nationale de la Recherche au titre du programme " Investissements d'avenir " portant la référence ANR-10-LABX-93-01. This work was supported by the French National Research Agency, through the program Investissements d'Avenir, ANR-10--LABX-93-01.
Mots-clés
en
Spatial health disparities, Economic geography, Stratified duration model